Abstract
Objective The aim of this study was to compare the functional outcome and complications in midshaft clavicle fractures receiving minimally invasive plate osteosynthesis and conventional open plating. MethodsRelevant studies were searched in the databases of Medline, EMBASE, Cochrane Library, Ovid, and Web of Science from inception to March 1, 2019. Pooled data were analyzed with Cochrane Collaboration's Review Manager 5.3. Results A total of 7 studies were included, of which 2 were randomized controlled trials, 3 were retrospective cohort studies, and 2 were prospective cohort studies including 316 patients. No statistical differences in functional outcome (weighted mean difference [WMD] = 0.99, P = 0.12), operation time (WMD = −10.44, P = 0.07) and time to bone union (WMD = −0.23, P = 0.70) were observed between the two groups. However, minimally invasive plate osteosynthesis reduced rates of skin numbness (odds ratio (OR) = 0.25, 95% CI : 0.13 to 0.48; P < 0.0001) and complications (OR = 0.33, 95% CI : 0.16 to 0.71; P = 0.005) compared with conventional open plating. Conclusion This systematic review and meta-analysis found no differences in terms of functional outcomes, operation time, and fracture healing time between minimally invasive plate osteosynthesis and conventional open plating. However, minimally invasive plate osteosynthesis had apparent advantages in rates of skin numbness and complications.
Highlights
Objective. e aim of this study was to compare the functional outcome and complications in midsha clavicle fractures receiving minimally invasive plate osteosynthesis and conventional open plating
Conventional open plating (COP) may compromise blood supply, so tissues, and cause several adverse events especially anterior chest numbness or hypoesthesia [8]. e minimally invasive plate osteosynthesis (MIPO) technique was widely used for lower extremity fractures owing to its role in protecting periosteal blood supply of the fracture area [9]
A er reading the full text of these 7 articles, no article was excluded based on the selection criteria. erefore, 7 articles were included in the systematic review [12, 13, 19,20,21,22,23] (Figure 2)
Summary
Two reviewers (Enzhe Zhao, Rui Zhang) screened title and abstract of the search results independently, and removed duplicate articles. Both reviewers screened potentially relevant articles in full for evaluation. E exclusion criteria were as follows: (a) studies without controlled groups; (b) duplicate publication; (c) pathological fractures; (d) unavailable relevant data. According to the Cochrane Collaboration recommendations, two reviewers (Enzhe Zhao and Yao Guo) assessed the methodological quality of each included study independently, and a third reviewer (Dou Wu) solved any possible inconsistency. Two researchers independently extracted the baseline study data as follows: the rst author’s name, study design, year of publication, interventions, sample size, mean age, follow-up time, operative time, complications, time to bone union, and functional outcomes. Sensitivity analysis was evaluated by sequentially removing outlier studies, one at a time
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